Dirschl D R, Almekinders L C
University of North Carolina, Division of Orthopaedics, Chapel Hill.
Drugs. 1993 Jan;45(1):29-43. doi: 10.2165/00003495-199345010-00004.
Infections involving bone continue to be a common problem. In children this is usually an acute haematogenous osteomyelitis. Early diagnosis with culture of an aspiration specimen is of paramount importance. Treatment with antibacterial agents is often successful unless pus is obtained in aspiration. In cases with an established abscess, surgical drainage is often needed in addition to antibiotic treatment. Staphylococcus aureus is the most common causative organism, although other microbes are often found in special circumstances such as in neonates, patients with sickle cell disease and those with nail puncture wounds. In adults, a pyogenic osteomyelitis is often due to direct trauma and generally is chronic in nature. Surgical debridement is the mainstay of treatment in these cases. Antibiotic treatment is often helpful but not curative by itself. Fungal and mycobacterial osteomyelitis is especially common in immunocompromised hosts. Amphotericin B remains the preferred treatment for fungal infections. Long term antituberculous multiple drug therapy is often sufficient to treat mycobacterial osteomyelitis.
累及骨骼的感染仍然是一个常见问题。在儿童中，这通常是急性血源性骨髓炎。通过抽吸标本培养进行早期诊断至关重要。除非抽吸到脓液，否则使用抗菌药物治疗通常会成功。在已形成脓肿的病例中，除抗生素治疗外，通常还需要手术引流。金黄色葡萄球菌是最常见的致病微生物，不过在特殊情况下，如新生儿、镰状细胞病患者以及有指甲刺伤伤口的患者中，常可发现其他微生物。在成人中，化脓性骨髓炎通常由直接创伤引起，一般为慢性。手术清创是这些病例治疗的主要手段。抗生素治疗通常有帮助，但仅凭其本身无法治愈。真菌性和分枝杆菌性骨髓炎在免疫功能低下的宿主中尤为常见。两性霉素B仍是真菌感染的首选治疗药物。长期联合抗结核药物治疗通常足以治疗分枝杆菌性骨髓炎。
